Venous Ulcers and Treatment
When the vein valves or the calf muscle pump in the leg does not work properly, normal blood flow is prevented and blood pools in the lower leg. The vein walls then become stretched and the valves are no longer able to close tightly. As this occurs, pressure increases in the leg veins resulting in leg swelling. Swollen, congested tissue in the legs cannot receive proper amounts of oxygen and nutrients. Waste products cannot be transported back into circulation, so they build up in the tissue. As a result, the skin of the ankle and lower leg can develop an open sore, also known as a venous ulcer. Even a slight injury to a swollen leg can result in skin breakdown. This condition is known as chronic venous insufficiency or the post-phlebitic syndrome.
- Congenital valve defects
- Congestive heart failure
- Family history
- History of a deep vein thrombosis, a blood clot
- Standing or sitting for long periods of time
Signs of venous insufficiency occur mainly in the lower calf or ankle of the leg and may include:
- Clear fluid drainage
- Dry, scaly, itchy or thickened skin
- Leg swelling
- Open sore (ulcer)
- Pain when standing, relief with leg elevation
- Skin discoloration (brownish color)
Certain tests are done to detect the cause and extent of venous insufficiency.
Identification and treatment of the underlying disease and proper wound care often leads to healing of longstanding wounds. The majority of patients with venous ulcers are treated conservatively with medical therapy; however, open surgical intervention may be indicated. The goals of treatment are to:
- Prevent or reduce infection
- Prevent recurrence
- Promote healing of ulcers
- Reduce leg swelling
One or more of the following treatment options may be recommended.
Antibiotics when indicated
Leg Compression/Elastic Support: Strong elastic support, elastic bandages or stockings, should be worn at all times. The bandage or stocking should be applied before getting out of bed and may be removed at night.
Leg Elevation: Elevate your legs above the level of the heart for 30 minutes three to four times a day. A foam wedge or several large pillows may also be used to help raise the legs.
Multilayer Compression Wrap: This dressing consists of three to four layers that are wrapped from the toes to just below the knees. The first layers are for padding and control of drainage and the outer layers provide compression. This dressing is similar to an Unna boot in its care, frequency of dressing changes and its ability to heal ulcers.
Topical Wound Care: If the leg ulcers are large and/or infected, topical wound care may be used. Depending upon the ulcer, topical wound care may require frequent dressing changes. An elastic bandage may be applied over the dressing.
Unna Boot: An Unna boot is a moist gauze bandage made up of zinc oxide, calamine lotion and glycerine. It promotes healing, increases blood return to the heart and reduces infection. The boot is wrapped from the toes to just below the knee, covering the ulcer and the lower leg. A new boot is applied every one to two weeks until the ulcer is healed.
Skin graft or skin substitutes: A skin graft or a skin substitute may be needed for severe ulcers.
Vein surgery: Surgery may be performed by removing the superficial and/or perforating veins that cause blood to pool and block the supply of nutrients to the skin. The veins are removed by making small incisions over the area of the venous ulcer.
Wound debridement: Debridement, the removal of unhealthy tissue from a wound to promote healing, is the mainstay of treatment.
Ongoing clinical research trials at the Center for Vascular Disease are investigating new treatment options for venous ulcers to ensure that our patients continue to receive the most innovative care in the country. For more information regarding these clinical trials, please view the clinical trial, send an e-mail or call 312-695-3908.
Contact Us Today
For more information regarding venous ulcers and the treatments available, please call the Bluhm Cardiovascular Institute at 1-866-662-8467. To schedule an appointment, please call 312-695-4965 or request a first time appointment online.